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Context: International comparisons of the health of mothers and babies provide essential benchmarks for guiding health practice and policy, but statistics are not routinely compiled in a comparable way. These data are especially critical during health emergencies, such as the coronavirus disease (COVID-19) pandemic. The Population Health Information Research Infrastructure (PHIRI) project aimed to promote the exchange of population data in Europe and included a Use Case on perinatal health. Objective: To develop and test a protocol for federated analysis of population birth data in Europe. Methods: The Euro-Peristat network with participants from 31 countries developed a Common Data Model (CDM) and R scripts to exchange and analyse aggregated data on perinatal indicators. Building on recommended Euro-Peristat indicators, complemented by a three-round consensus process, the network specified variables for a CDM and common outputs. The protocol was tested using routine birth data for 2015 to 2020; a survey was conducted assessing data provider experiences and opinions. Results: The CDM included 17 core data items for the testing phase and 18 for a future expanded phase. 28 countries and the four UK nations created individual person-level databases and ran R scripts to produce anonymous aggregate tables. Seven had all core items, 17 had 13-16, while eight had ≤12. Limitations were not having all items in the same database, required for this protocol. Infant death and mode of birth were most frequently missing. Countries took from under a day to several weeks to set up the CDM, after which the protocol was easy and quick to use. Conclusion: This open-source protocol enables rapid production and analysis of perinatal indicators and constitutes a roadmap for a sustainable European information system. It also provides minimum standards for improving national data systems and can be used in other countries to facilitate comparison of perinatal indicators.

Investigate the association between mode of delivery and perinatal outcomes in premature infants with neurodevelopmental risk factors. Using Croatian Institute of Public Health childbirth database records, outcomes of preterm infants born in 2018 and diagnosed with pathological conditions associated with neurodevelopmental risk were analysed with regard to mode of delivery (vaginal, caesarean section – CS). Common pathologic findings/conditions associated with neurodevelopmental risk included: 5-minute Apgar score below 7, intrapartal hypoxia or asphyxia, intracranial haemorrhage (grade 3 or 4) and pulmonary pathology (respiratory distress, pulmonary haemorrhage, pneumothorax, other respiratory disorders). In some premature infants, multiple neurodevelopmental risk factors were reported. Other causes of morbidity were included in a common subgroup – Other entities. Data on early neonatal death (END) of premature infants caused by aforementioned conditions were also analysed. In 2018, 2, 232 premature infants were born in Croatia (6% of all live-births). Pathological conditions were reported in 1, 926 (86.2%) preterm infants, whereof 430 (19.3%) were primarily diagnosed with entities related to neurodevelopmental risk. 5-minute Apgar score below 7 was observed in 176 (7.9%) children, whereof 68.2% were delivered by CS and 31.8% vaginally. Hypoxia or asphyxia were the primary diagnosis in 33 (1.5%) and a secondary diagnosis in 107 (4.8%) children (140 in total – 6.3%) ; 58.6% were delivered by CS and 41.4% vaginally. Intracranial haemorrhage (grade 3 or 4) was the primary diagnosis in 19 (0.9%) children and a secondary diagnosis in 102 (4.6%), a total of 121 (5.4%) ; 92.5% were delivered by CS and 7.5% vaginally. Pulmonary disorders were the primary diagnosis in 378 (16.9%) children and a secondary diagnosis in 424 (19.0%) – a total of 802 (35.9%) ; 55.7% were born by CS and 44.3% vaginally. Other conditions were the primary cause of morbidity in 1, 496 children (66.8%), whereof 50.5% were delivered by CS and 49.5% vaginally. Among 306 (13.7%) children recorded without any pathological condition, 41.5% were born by CS and 58.5% vaginally. Among 78 END cases, conditions related to neurodevelopmental risk (pulmonary pathology, intracranial haemorrhage) were the cause of death in 15 (19.2%) ; however, in additional 44 (56.4%) cases causes of death were indirectly associated with neurodevelopmental risk, except 19 (24.4%) deaths caused by congenital malformations. In preterm infants without neurodevelopmental risk factors, the incidence of CS and vaginal delivery were similar. Premature infants with conditions related to neurodevelopmental risk were more frequently delivered by CS as a means to prevent neurological and other impairments and perinatal death.

Objective To present prevention activities in primary health care of infants and preschool children in Croatia during 2018, based on data from Central Health Information System of the Republic of Croatia (CEZIH). Methods Health care of infants (up to one year of age) and preschool children (1-6 years of age) is in Croatia provided within the pre-school children’s health service and the family (general) medicine service. More than 90% of children is in care of primary pediatricians and the rest of them in the care of general practitioners. Practices which are contracted by Croatian Health Insurance Fund routinely send electronic mes sages with information about the patient and individual visit through CEZIH. As of 2018, Croatian Institute of Public Health also has partial access to those data, for the purpose of analyzing preventive and curative work of primary health care services. In this paper, based on CEZIH data, preventive visits of infants and preschool children in both pre-school children’s health service and family (general) medicine service in 2018 are analyzed. The term ‘preventive visit’ refers to any contact with primary health-care providers: visit, examination, telephone counselling and other contacts for preventive proce dures. Each of these procedures has its own code in the list of diagnostic and therapeutic procedures. Results During 2018, total number of health care users aged 0 to 6 was 272, 043, with 2, 611, 939 visits. Among them, there were 37, 619 infants with 533, 880 visits, an average of 14.2 visits per infant, while preschool children had an average of 8.9 visits. Among the total visits, 504, 469 preventive visits were recorded (19.3% of all visits), of which 327, 637 were examinations, and 176, 832 were counselling sessions. Out of total number of preventive examinations, there were 281, 029 check-up examinations (85.8%), of which 166, 240 in infants (4.4 per infant) and 114, 789 in preschool children (0.5 examinations per child). During preventive visits, a total of 107, 483 referrals were issued (17.6% of all issued referrals), of which 57.3% for infants. Most referrals from preventive visits of infants were for diagnostic purposes (40.1%), and from preventive visits of preschool children for the examina tion by consultant physician (52.2%). Conclusion According to CEZIH data, preventive activities account for a fifth of the total activities in children´s health care on a primary level. The plan and program of health care measures sets four check-up examinations in infants, which, according to CEZIH data, has been achieved. However, in the period after the first year of life, three systematic examina tions per preschool child were not performed or data on this were not recorded in the CEZIH. On average, every fifth pre ventive visit results in the discovery of a pathological condi tion due to which the infant or young child is referred for further treatment. Monitoring the growth and development of children by conducting regular check-up examinations is an important measure in the prevention and early detection of developmental disorders and the preservation of children´s health.

Objective To determine the prevalence of selected prenatal neurodevelopmental risk factors in premature infants in Croatia. Methods The medical records used in this study were col lected via the National Medical Birth Record Database of the Croatian Institute of Public Health and pertained to all live born children delivered before 37 weeks of gestation in 2018. The data were subsequently extracted from the said records in order to analyse the prevalence of the following prenatal neu rodevelopmental risk factors as defined in the International Classification of Diseases, 10th revision: chorioamnionitis (O41.1), placental or umbilical cord disorders (O43 – O45, O69), hypertensive disorders during pregnancy (O10 – O16), gestational diabetes (O24) and smoking during pregnancy. When applicable, causes of early neonatal death among pre mature infants were analysed as well. Results 2, 232 premature infants were recorded in Croatia in 2018, i.e. 6% of all live-born children. 116 (5.2% of all pre mature infants) were delivered between 22 and 27 weeks of gestation, 232 (10.4%) between 28 and 31 weeks of gestation and 1, 884 (84.4%) between 32 and 36 weeks of gestation. The selected neurodevelopmental risk factors were recorded in 574 (25.7%) premature infants. The prevalence rates of selected pregnancy-related complications/disorders were as fol lows: placental or umbilical cord disorders in 169 (7.6%) pre mature infants, hypertensive disorders in 160 (7.2%), smoking during pregnancy in 128 (5.7%), gestational diabetes in 120 (5.4%), chorioamnionitis in 77 (3.5%). Multiple risk factors were recorded in 74 (12.9%) premature infants at neurodeve lopmental risk. Neurodevelopmental risk factors were recorded in 74 infants delivered prior to 27 weeks of gestations (preva lence rate: 637.9/1, 000), 95 infants delivered between 28 and 31 weeks (409.5/1, 000), and 485 infants delivered between 32 and 36 weeks (257.4/1, 000). The risk of neurodevelopmental disorders was thus 1.6 and 2.5 times higher among infants delivered between 22 and 27 weeks of gestation compared with infants delivered between 28 and 31 weeks of gestation and between 32 and 36 weeks of gestation, respectively. The most frequently recorded neurodevelopmental risk factors by gestational age groups were chorioamnionitis in infants deliv ered before 27 weeks of gestation (44.6%), placental or umbilical cord disorders among infants delivered between 28 and 31 weeks of gestation (32.6%), and hypertensive disorders in infants delivered between 32 and 36 weeks of gestation (27.2%). 78 early neonatal death were recorded in the studied group (mortality rate: 35.0/1, 000) ; mortality rates by gesta tional age groups were 431.0/1, 000 among infants delivered between 22 and 27 weeks of gestation, 77.6/1, 000 among infants delivered between 28 and 31 weeks of gestation and 5.3/1, 000 among infants delivered between 32 and 36 weeks of gestation. Chorioamnionitis was the leading cause of death among infants delivered between 22 and 27 weeks of gesta tion (specific mortality rate: 146.6/1.000) ; other significant causes of mortality in this age group were prematurity-related disorders (respirational distress disorder, pulmonary atelectasis, pulmonary haemorrhage, intraventricular bleeding (112, 1/ 1.000). Conversely, congenital malformations were the leading cause of death in infants delivered between 28 and 31 weeks of gestation (30.2/1, 000) and infants delivered between 32 and 36 weeks of gestation (3.7/1, 000). Conclusion The negative association between the duration of pregnancy and the prevalence of neurodevelopmental risk fac tors in infants has been confirmed by this study. The preva lence of particular risk factors, however, differed among different gestational age groups. Chorioamnionitis was the most prevalent neurodevelopmental risk factor and most fre quent cause of death among infants delivered between 22 and 27 weeks of gestation. Placental and umbilical cord disorders were the most prevalent risk factor among infants delivered between 28 and 31 weeks of gestation, whereas hypertensive disorders most prevalent risk factor among infants delivered between 32 and 36 weeks of gestation. Both groups of disor ders are associated with hypoxia and neurodevelopmental dis abilities. The Perinatal Health Care Service Programme, recently adopted in Croatia, defines various health care proce dures allowing for early diagnosis of pregnancy-related infec tious and hypertensive disorders, as well as ultrasound screening for placental circulation disorders. These procedures may contribute to early detection of neurodevelopmental risk factors and prevention of neurodevelopmental disorders.

Introduction and objectives. Elderly are the largest group of users of prescription medications. Over 20 % of the population in Croatia is older than 65 years and this proportion is expected to increase as the population is ageing. Due to the multi-morbidities, multiple concomitant medicines, and underlying metabolic and cognitive changes, drug prescribing in the elderly can result in adverse health outcomes and unnecessary costs for the health system. The objective of our work is to explore the potential of secondary use of routinely collected health data for generating the evidence in support of healthy ageing, using potentially inappropriate drug prescribing as a case study. Methods. The Central Health Information System of the Republic of Croatia (CEZIH) is the largest source of routinely collected health data in Croatia. Based on the published functional specification, we analysed CEZIH in terms of its structure and available data elements. As a measure of inappropriate drug prescribing, we chose the internationally accepted STOPP/START criteria (Screening Tool of Older People’s Prescriptions and Screening Tool to Alert to Right Treatment) for prescribing in older people. We compared the data contained in CEZIH with the information needed for the implementation of the STOPP/START criteria. Results. The STOPP/START criteria provide 114 evidence based rules to avoid commonly encountered points of potentially inappropriate prescribing. The precondition to apply those rules is availability of information on patient age, prescribed medications, indications, medical conditions. ePrescription contains structured information for over 99% of medicines prescribed/ dispensed in the primary care setting since 2011. The attributes available in ePrescription include brand name, active substance, dose, form, indication, date of prescription and dispensation, patient identifier which allows for application of 38 STOPP/START criteria. Additional information can be retrieved from the electronic healthcare record within CEZIH (64 criteria). Conclusion. Routinely collected electronic patient data in Croatia can be used to generate the evidence on inappropriate drug prescribing using STOPP/ START criteria. Such analyses have been done in many countries to assess suboptimal prescribing practices, however, in Croatia, this has not been the case despite the importance of the issue. Secondary use is a complex process that requires accessible data, understanding of data sources, data structure and research methodologies. Interdisciplinary and inter-institutional collaboration is important to make the most of the results and to support regulatory actions and policy development.

Uvod: Za praćenje pokazatelja dojenja, prema Nacionalnom programu za zaštitu i promicanje dojenja, od velike su važnosti i podaci iz rodilišta koji se prikupljaju na prijavama porođaja kao obveznom zdravstveno-stati- stičkom izvješću. Prema obilježjima koje se prate iz javnozdravstvenih zapisa iz rodilišta (prijava porođaja) trebali bi se dobiti podaci o vrsti prehrane (majčino mlijeko, zamjena za majčino mlijeko ili dvovrsna mliječna prehrana) kao i podatak o vremenu prvog podoja u onim rodilištima (16/32 rodilišta) koja se nalaze u sustavu E-novorođenče jer se u e-prijavama bilježi datum i vrijeme porođaja te vrijeme proteklo od porođaja do prvog podoja. Cilj: Utvr- diti kvalitetu i kvantitetu pokazatelja dojenja iz rodilišta temeljem prijava porođaja za 2018. godinu. Rezultati: Prema pristiglim prijavama, u 2018. godini je bilo 37.277 živorođene djece. Isključivo majčinim mlijekom je hra- njeno 72% djece, dvovrsnom mliječnom prehranom (majčino mlijeko + „infant formula“) 23, 9%, a zamjenom za majčino mlijeko 1, 7%. Nije hranjeno na usta 2% novorođenčadi, a za 0, 4% nije bilo podataka o prehrani. Podatak o prvom podoju je dostupan u 22.560 zapisa o novorođenčetu, a ovih podataka nemaju rodilišta koja nisu u E-novorođenče sustavu, ukupno njih 14.717 ili 39, 5%. Od onih koji imaju taj podatak, unutar prvog sata života je podoj uspostavljen kod 63, 3% novorođenčadi. Zaključak: Da bi mogli ocijeniti koliko se uspješno provode mjere promicanja dojenja u rodilištima, određene Nacionalnim programom za zaštitu i promicanje dojenja, potrebno je imati potpune i točne podatke iz rodilišnih prijava porođaja. Podaci o prehrani novorođenčadi u rodilištima služe kao neizravan pokazatelj uspješnosti edukativnih i zdravstveno-odgojnih mjera namijenjenih trudnicama i zdrav- stvenom osoblju u svrhu primjene preporuka o dojenju Svjetske zdravstvene organizacije

U Hrvatskoj je u 2015. godini 260 perinatalno umrlih (176 mrtvorođenih i 84 rano neonatalno umrla) u dobi ≥22 tjedna trudnoće odnosno 240 perinatalno umrlih (160 mrtvorođenih i 80 rano neonatalno umrlih) ≥500 g porođajne težine. Perinatalna smrtnost za rođene ≥22 tjedna trudnoće iznosi 6, 9‰, a za rođene ≥500g 6, 3‰. Iz prijevremenih porođaja je 65 rano neonatalno umrlih (77, 4%), znatno manje nego u 2014. godini (102–79, 1%). Od 176 mrtvorođenih je 129 (73, 3%)